Medicare's principal care management code isn't delivering the relationship-based primary care it promised

A billing code designed to reimburse primary care physicians for the ongoing, between-visit work of managing complex Medicare patients has not translated into the intended shift toward relationship-based, continuous care. Physician and researcher Ishani Ganguli argues in STAT News that the structural incentives remain misaligned with what primary care actually requires.

Why it matters

The principal care management billing code was built on a reasonable premise: that primary care physicians do significant work outside the office visit, and that Medicare should pay for it. The idea was that reimbursing this work would free up time and attention for the kind of longitudinal, relationship-based care that complex patients need. What Ganguli's analysis suggests is that the code has been adopted without producing that shift in practice.

This matters beyond the specific code. It points to a recurring pattern in payment reform where a new mechanism gets layered onto an unchanged system and then absorbed by it. The physicians and administrators closest to this work should be asking whether the problem is the code's design, the panel sizes that make relationship-based care structurally impossible, or both. Getting that diagnosis right is the prerequisite for any solution worth building.

What to watch

Whether CMS uses this evidence to redesign the code's eligibility and documentation requirements, or simply moves on to the next payment experiment without a real after-action review.